Case Report

Two Unusual Sequelae of Tuberculous Meningitis Despite Treatment

Authors: Allen J. Blaivas, DO, Alfred Lardizabal, MD, Reynard Macdonald, MD

Abstract

We describe the case of a 22-year-old HIV-negative male who was diagnosed with tuberculous meningitis and subsequently went on to develop two highly unusual after effects of the meningitis. The first was a tuberculoma, which was discovered 28 days after the meningitis and occurred while the patient was taking a four-drug therapeutic regimen, despite adequate drug susceptibilities. The second was an even more unique sequela: tuberculous radiculomyelitis. This transpired only after the patient’s glucocorticoids, which were initiated to treat the tuberculoma, were tapered off. These manifestations were successfully treated with the addition of corticosteroids to the antituberculous regimen. The typical clinical presentations of these diseases are reviewed and various means of pathogenesis proposed.


Key Points


* Tuberculoma and tuberculous radiculomyelitis are possible sequelae of even appropriately treated tuberculous meningitis.


* Corticosteroids are useful to treat both of these manifestations of central nervous system tuberculosis in conjunction with continued use of antituberculous treatment.


* The exact etiologies of these diseases are poorly understood, though several theories have been advanced.


* Unrecognized tuberculoma or tuberculous radiculomyelitis can lead to severe dysfunction and require prompt recognition and treatment.

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